Children’s Health Insurance Program (CHIP)

FY 14 $9,513,914,000, FY 15 $10,387,942,000; est.Range of the grants provided in 2014 as financial assistance is from $250,000 to $500,000

Main objective of Children Health Insurance Program is provide federal grants for maintaining and expanding child health assistance to uninsured children coming from low-income families.

Each State can opt to use part of the appropriated grants to extend the health assistance to uninsured low-income pregnant women and legal immigrants as well. Children Health Insurance Program typically cover a range of benefits that may include doctor visits, emergency care, hospital care, vaccinations, prescription drugs, vision, hearing and dental.

Federal grants are used in three ways to achieve the objective of the CHIP:

Obtaining health insurance coverage for uninsured children that meets certain required duration and scope of the benefits;

Expanding eligibility for children under the State’s Medicaid program;

Achieving the CHIP objective by a combination of both.

In addition to the grants for children’s health insurance the Federal Government provides specific grant each year, (e.g. $32 million for 2012) to help families understand the application procedure and health coverage opportunities, including Medicaid, CHIP and insurance affordability programs under the Affordable Care Act (ACA). Federal rules also allow States to spend up to 10 percent of their total CHIP grants (Federal and State) on non-benefit activities, including: outreach conducted to identify and enroll eligible children in CHIP; administration costs; health services initiatives; and other child health assistance.

Any State child health plan must include a description of the amount (if any) of cost-sharing for child health assistance. Cost-sharing amounts may be varied in a way that does not favor higher-income children over lower-income children. There is no cost-sharing for well-baby and well-child care, including age-appropriate immunizations. Cost-sharing for children at 150 % of poverty must be consistent with Medicaid. Cost-sharing for children at 150 % of poverty and above must be based on an income-related sliding scale. The aggregate cost sharing for all children in a family cannot exceed 5 % of the family’s income.

Health insurance coverage provided for low-income pregnant women under the CHIP may include coverage of abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest.

Beneficiary Eligibility

Beneficiaries of the federal grants spend for CHIP are low-income children who have been determined eligible by the State for child health assistance under their State plan. Standards used to determine eligibility may include those related to geographic areas to be served by the plan.

Age, income and resources, residency, disability status (as long as the standard does not restrict eligibility), access to or coverage under other health coverage, and duration of eligibility are factors. Standards may not discriminate on the basis of diagnosis. Eligibility standards must not cover higher-income children without covering lower-income children, and must not deny eligibility based on a child having a pre-existing medical condition. The State must ensure that only targeted low-income children are furnished child health assistance under the plan.